Abstract: Introduction: dextrocardia - is a congenital heart disease, in which the heart is located in right half of chest. Incidence of ischemic heart disease in patients with dextrocardia is unknown, but some authors write that it is the same as in the general population. Guiding principles of endovascular treatment of chronic total occlusion (CTO) of coronary arteries, consider dualcatheter angiography to be an obligatory option for successful recanalization. Aim: was to estimate possibilities of DRON-access and various radial accesses in treatment of multivessel disease in a patient with dextrocardia, severe comorbidity, and single vascular access. Material and methods: we present case report of a 63-year-old female patient, who previously had ischemic stroke with tleft-sided hemiplegia; she was examined before surgery for instability of the prosthesis of right hip joint. Coronary angiography through traditional radial access revealed multivessel lesions of coronary arteries: chronic total occlusion (CTO) of right coronary artery, stenosis of the left anterior descending artery (LAD) in proximal and distal third; eccentric circumflex artery (Cx) stenosis. Further examination revealed: severe spastic paralysis of left hand, occlusion of left common femoral artery, chronic osteomyelitis of right leg with suppuration. Medical consilium decided to perform staged endovascular revascularization of the myocardium. For this purpose, to provide access for double-catheter recanalization of CTO and subsequent interventions, DRON-access (Distal radial and Radial One-handed accesses for interventions iN chronic occlusions of coronary arteries) and various radial accesses were used. Results: at the first stage, using DRON-access, we performed double-catheter angiography and CTO recanalization of right coronary artery (RCA) with stenting. At the second stage, through traditional radial access, we performed angioplasty and stenting of LAD at two levels. After 3 months, control coronary angiography was performed through distal radial access: implanted stents had no signs of restenosis, there was no progression of atherosclerotic process. Patient was discharged to prepare for correction of instability of right hip joint prosthesis. Conclusions: patients with severe and variable comorbidities require not only a multidisciplinary approach, but also, in various of clinical situations, need personalized approach. The use of DRON-access may allow operators to perform endovascular intervention using double-catheter angiography even in patients with single vascular access, which meets modern criteria for providing care for chronic coronary artery occlusions.
Abstract: Introduction: development of intravascular diagnostic methods has significantly increased the amount of information in the study of various vessels in comparison with standard angiography. Technological and software improvement of optical coherence tomography (OCT) allows expanding diagnostic capabilities and providing greater convenience for analyzing of results of this method of intravascular examination, which leads to an increase in its importance both for daily clinical practice and in scientific research. Aim: was to describe the methodology of performing a new modification of OCT and to analyze accumulated experience, advantages and possibilities provided by this method. Material and methods: the modern version of the complex for optical coherence tomography OPTIS allows to implement such new features as automatic indication of malapposition of stents, easy-to-perceive three-dimensional image of examination data in various versions, joint presentation (co-registration) of angiography and OCT data in real time. The first experience of clinical use of this system in the Russian Federation is presented, with an analysis of priority indications for the use of new possibilities. Using the angio-OCT-co-registration function, 309 studies of 205 arteries in 178 patients were performed, which accounted for 63,3% of all OCT procedures performed in our department. Results: priority indications for the use of the method were identified, which primarily include: cases of extended stenoses with an uncertainty in the hemodynamic significance of individual sections or the entire lesion as a whole; difficulties in constructing an optimal projection of the angiogram (without overlapping branches and significant shortening of the target area); bifurcation lesions; diagnostics of thrombus, dissections, plaque ruptures, severe calcification, including in acute coronary syndrome; selection of the optimal size of biodegradable scaffold and preparation of the artery for its implantation; intermediate or final control of results of coronary artery stenting. The use of co-registration of angiography and OCT contributes to a more accurate determination of the area of interest during repeated studies, which is especially important for the dynamic assessment of the patient's condition and for scientific research. Conclusions: the development and modernization of optical coherence tomography causes an increase in its importance both in daily clinical practice and in scientific research. The possibility of spatial co-registration of OCT data with angiographic images, as well as new options for automatic processing of resulting images, including stent apposition assessment, significantly increase the operator's ability to quickly and accurately analyze examination data directly at the operating table. References 1. Demin VV. Clinical guide to intravascular ultrasound. Orenburg. Yuzhnyj Ural. 2005: 400 [In Russ]. 2. Raber L, Mintz GS, Koskinas KC, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2018; 14: 656-677. https://doi.org/10.4244/EIJY18M06_011 3. Johnson TW, Raber L, di Mario C, et al. Clinical use of intracoronary imaging. Part 2: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2019; 15: 434-451. https://doi.org/10.4244/EIJY19M06_02 4. Van der Sijde JN, Guagliumi G, Sirbu V, et al. The OPTIS Integrated System: real-time, co-registration of angiography and optical coherence tomography. EuroIntervention. 2016; 12: 855-860. https://doi.org/10.4244/EIJV12I7A140 5. Karanasos A, Van der Sijde JN, Ligthart J, et al. Utility of Optical Coherence Tomography Imaging with Angiographic Co-registration for the Guidance of Percutaneous Coronary Intervention. Radcliffe Cardiology.com. 2015. [Internet source] 6. Demin VV, Demin DV, Seroshtanov EV, et al. Clinical issues of optical coherence tomography for coronary diagnosis. International Journal of Interventional Cardioangilogy. 2016; 44: 34-48 [In Russ]. 7. Ermolaev PA, Khramykh TP, Vyaltsin AS. Use of optical coherence tomography for intermediate coronary artery lesions. Circulation Pathology and Cardiac Surgery. 2019; 23(3): 47-56 [In Russ]. https://doi.org/10.21688/1681-3472-2019-3-47-56 8. Onuma Y, Okamura T, Muramatsu T, et al. New implication of three-dimensional optical coherence tomography in optimising bifurcation PCI. EuroIntervention. 2015; 11: 71-74. https://doi.org/10.4244/EIJV11SVA15 9. Alegr?a-Barrero E, Foin N, Chan PH, et al. Optical coherence tomography for guidance of distal cell recrossing in bifurcation stenting: choosing the right cell matters. EuroIntervention. 2012; 8: 205-213. https://doi.org/10.4244/EIJV8I2A34 10. Tyczynski P, Ferrante G, Kukreja N, et al. Optical coherence tomography assessment of a new dedicated bifurcation stent. EuroIntervention. 2009; 5: 544-551. https://doi.org/10.4244/EIJV5I5A89 11. Souteyrand G, Amabile N, Combaret N, et al. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions. EuroIntervention. 2015; 11: 895-904. https://doi.org/10.4244/EIJY14M07_18 12. Souteyrand G, Arbustini E, Motreff P, et al. Serial optical coherence tomography imaging of ACS-causing culprit plaques. EuroIntervention. 2015; 11: 319-324. https://doi.org/10.4244/EIJV11I3A59 13. Mustafina IA, Pavlov VN, Ishmetov VSh, et al. Identification of plaque morphology in acute coronary syndrome by optical coherence tomography. Bashkortostan Medical Journal. 2017; 12; 4(70): 27-32 [In Russ]. 14. Allahwala UK, Cockburn JA, Shaw E, et al. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EuroIntervention. 2015; 10: 1154-1159. https://doi.org/10.4244/EIJV10I10A190 15. Shugushev ZK, Maksimkin DA, Vorob'eva YuS, et al. Results of biodegradable vascular endoprotheses implantation in ischemic heart disease patients with type 2 diabetes. Russian Journal of Cardiology. 2016; 9(137): 19-24 [In Russ]. https://doi.org/10.15829/1560-4071-2016-9-19-24 16. R?ber L, Radu MD. Optimising cardiovascular outcomes using optical coherence tomography-guided percutaneous coronary interventions. EuroIntervention. 2012; 8: 765-771. https://doi.org/10.4244/EIJV8I7A118 17. Tanigawa J, Barlis P, Dimopoulos K, et al. Optical coherence tomography to assess malapposition in overlapping drug-eluting stents. EuroIntervention. 2008; 3(5): 580-583. https://doi.org/10.4244/EIJV3I5A104 18. Radu M, J?rgensen E, Kelb?k H, et al. Optical coherence tomography at follow-up after percutaneous coronary intervention: relationship between procedural dissections, stent strut malapposition and stent healing. EuroIntervention. 2011; 7: 353-361. https://doi.org/10.4244/EIJV7I3A60 19. Trusov IS, Nifontov EM, Biryukov AV, et al. The use of optical coherence tomography imaging of the vascular wall of the coronary arteries before and after stenting. Regional blood circulation and microcirculation. 2019; 18(1): 77-85 [In Russ]. https://doi.org/10.24884/1682-6655-2019-18-1-77-85 20. Demin VV, Galin PYu, Demin DV, et al. The comparison of intravascular ultrasound guided and angiography guided implantation of drug-eluting stents: The randomized trial ORENBURG. Part 1: Study design, direct clinical results. Diagnostic & Interventional Radiology. 2015; 9(3): 31-43 [In Russ]. 21. Demin VV, Murzajkina MM, Galin PYu, et al. Comparison between implantation of drug-eluting stents under control of intravascular ultrasound and angiography: The randomized trial ORENBURG. Part 2: The data of angiography and intravascular methods of visualization. Diagnostic & Interventional Radiology. 2016; 10(2): 31-47 [In Russ]. 22. Demin VV, Gusev SD, Murzaykina MM, et al. Immediate and early results of a clinical trial comparing different strategies of drug-eluting stents implantation under IVUS and angiographic guidance. International Journal of Interventional Cardioangilogy. 2016; 44: 49-59 [In Russ]. 23. Demin VV, Demin AV, Demin DV, et al. The drug-eluting balloons for coronary arterial restenosis: 7-year experience. International Journal of Interventional Cardioangilogy. 2016; 44: 59-71 [In Russ].
Abstract: Technological advance in multislice computed tomography (MSCT) set the radiologists all over the world thinking of its application in patients with ischemic heart disease. Proved diagnostic efficiency of 64-slice MSCT coronary angiography nominates the technique to be a first-line screening method for coronary atherosclerosis: it allows quick, accurate, and non-invasive imaging and quantitative assessment of coronary lesions. Though the indications for MSCT has already defined, there still are contro-versies about its place in diagnostic strategy. The aim of our study was to picture the state-of-the-art MSCT capabilities, focusing on MSCT coronary angiography and its place in contemporary clinical medicine. Reference 1. Achenbach S. et. al. Top 10 indications forcoronary СТА. Supplement to Applied Radiology.2006; 35 (12): 22-31. 2. Gaspar T., Halon R., Rubinshtein N. Clinicalapplications and future trends in cardiacСТА. Eur. Radiol. Suppl. 2005; 15 (l4): 10-14. 3. Jacobs J.E. How to perform coronaryСТА: A to Z, Supplement to Applied Radiology.2006; 12: 10-17. 4. Синицын В.Е., Воронов Д.А., Морозов С.П.Степень кальциноза коронарных артерийкак прогностический фактор осложнений сердечно-сосудистых заболеваний без клинических проявлений: результаты метаанализа. Терапевтический архив. 2006; 9: 22-27. 5. Терновой С.К., Синицын В.Е., Гагарина Н.В. Неинвазивная диагностика атеросклероза и кальциноза коронарных артерий. М: Атмосфера. 2003; 144. 6. Синицын В.Е., Устюжанин Д.В. КТ-ангиография коронарных артерий. Кардиология. 2006; 1: 20-25. 7. Ehara M., Surmely J.F., Kawai M. et al.Diagnostic accuracy of 64-slice computedtomography for detecting angiographicallysignificant coronary artery stenosis in an unselected consecutive patient population:Comparison with conventional invasiveangiography. Circ.J. 2006; 70: 564-571. 8. Leschka S. et al. Accuracy of MSCT coronaryangiography with 64-slice technology: firstexperience. Eur. Heart. J. 2005; 26: 1482-1487. 9. Wann S. Cardiac CT for risk stratification,Supplement to Applied. Radiology. 2006; 12: 41-44. 10. Hoffmann U., Moelewski F., Cury R.C. et al.Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease 17.in patients at high risk for coronary artery disease. Patient-versus segment-based analysis. Circulation. 2004; 110: 2638-2643. 11. Rienmuller R., Brekke O., Kampenes V.B. et al. Dimeric versus monomeric nonionic contrast agents in visualization of coronary arteries. Eur.J. Radiol. 2001; 38 (3): 173-178. 12. Dewey M. et al. Head-to head comparison of multislice computed tomography angiography and exercise electrocardiography for diagnosis of coronary artery disease. Eur. Heart. 2007; 10, 28 (20): 2485-2490. 13. Schlosser T., Konorza T., Hunold P. et al. Noninvasive visualization of coronary artery bypass grafts using 16-detector row computed tomography. JACC. 2004; 44: 1224-1229. 14. Chabbert V., Carrie D., Bennaceur M. et al. Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography (MDCT). Eur Radiol. 2007; 17: 1452-1463. 15. Schijf J.D., Bax J.J., Jukema J.W. et al. Feasibility of assessment of coronary stent patency using 16-slice computed tomography. Am.J. Cardiol. 2004; 94: 427-430. 16. Mahnken A.H., Buecker A., WildbergerJ.E. et al. Coronary artery stents in multislice computed tomography: in vitro artefact evaluation. Invest Radiol. 2003; 39: 27-33. 17. Cademartiri F., Marano R., Runza G. et al. Non-invasive assessment of coronary stent patency with multislice CT: preliminary experience. Radiol. Med. (Torino). 2005; 109 (5-6): 500-507.
Abstract: Diseases of the circulatory system in a few decades are one of the major causes of death and disability in the population in many countries around the world. In Russian Federation, a number of newly diagnosed cases of coronary heart disease and mortality of the working population of this pathology is growing. In clinical practice at the present time, various radiological techniques assess the condition of the heart and coronary vessels, determine the location and volume of lesions. In the available literature, however, we found no data on methods of research that would reveal the correlation between the X-ray anatomy of coronary vessels and structural and functional state of the heart muscle. Thus, the need for comprehensive scientific research is obvious. Results of this study will, on the basis of survey data, using the methods of radiation diagnosis, objectively assess the level of metabolic and structural and functional state of the cardiomyocytes in cardiac patients. This will improve the accuracy and informativeness of diagnosis, as well as the increase of the control of effectiveness of therapy and quality of patients' life with cardiac diseases. References 1. Pakkal M., Raj V., McCann G.P Non-invasive imaging in coronary artery disease including anatomical and functional evaluation of ischemia and viability assessment. The British Journal of Radiology. 2011; 84: S280-S295. 2. Boqueria L.A., Gudkova R.G. Cardiac Surgery - 2010. Diseases and congenital malformations of the circulatory system. Moscow: Publishing Bakoulev center for cardiovascular surgery of RussianAcademy of Medical Sciences. 2011. 192 p [In Russ]. 3. Lindenbraten L.D. Beam diagnostics: achievements and challenges of modern times. Radiology - practice. 2007, 3: 4-15[In Russ]. 4. Sharafeev A.Z. Diagnosis of associated atherosclerotic lesions of different pools in CHD patients. Kazan Medical Journal. 2009; XC (2), 145-148[In Russ]. 5. 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Sapozhkova L.P.). Rostov n / D: Phoenix. 2007, 137 p. [In Russ]. 10. Sinicyn V.E., Fomina I.G., Pisarev M.V., Gagarina N.V. Diagnostic and prognostic significance of detection of coronary calcification in the preclinical stage of ischemic heart disease. Cardiovascular therapy and prevention. 2004, 3 (5): 118-125 [In Russ]. 11. Kothawade K., Noel Bairey Merz C. Microvascular coronary dysfunction in women - pathophysiology, diagnosis and management. Curr. Probl. Cardiol. 2011; 36 (8): 291-318. 12. Gorge G., Ge J., von Birgelen C., Erbel R. Intracoronary ultrasound - the new gold-standart? Zeitschrift fur Kardiologie. 1998; 87 (8): 575-585. 13. Movsesyants M.Y, Ivanov V.A., Trunin I.V. Intravascular ultrasound with Virtual Histology in lesions of the coronary arteries. Cardiology. 2009, 12: 58- 61 [In Russ]. 14. Veselova T.N., Merkulova I.N., Yarovaya E.B., Ruda M. J. Evaluation of myocardial viability Metolit MSCT for the prediction of postinfarction left ventricular remodeling. 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Abstract: Aim: was to increase diagnostic value of cardiac CTA (CCTA) by estimation of the CCTA informative value in CA (Coronary arteries) diseases and optimization of OOTA procedure for reducing of radiation dose (RD). Materials and methods: CCTA informative value in CA diseases was assessed on the base of data of 200 patients (average age of patients was 60,4 (from 35 to 80 years), men/women ratio: 1.94:1(132/68). Parameters of coronary stenosis severities: its localization, extension, degree and characteristics of coronary stenosis. The study was performed with GE Optima 660 128-slice scanner and Missouri Ulrich injector with bolus injecting 60-100 ml of nonionic contrast media (350 mg/ml) at 4-6 ml/sec injector rate. For data processing used: «Auto Coronary Analysis» and «Auto Ejection Fraction» programs at - AW5 workstation. Results: discovered various severity degrees of atherosclerotic lesions based stenosis intensity up to 50% (46 /23,5%), 50-60% (65/33%), 60-70% (35/17,9%), 70-80% (26/13,5%), 80% and more (23/11,8%). CCTA data coincided with conventional coronary angiography in 89% cases. RD decreasment was achieved by: pitch change depending on heart rate, scan area optimization (reduction), kV and mAc with radiation exposure decline in CCTA to 7,0-8,0 mSv In pitch value increasing to 1,48 - RD decreased to 45% (20 mSv). In prospective synchronization with ECG, RD decreased to 65% (7-12 mSv) as X-Ray tube radiates the highest RD at 70% cardiac cycle phase (120kV/180-200mAc), in other phases (80kV/100 mAc) RD values were lower. Conclusion: CCTA is a valid non-invasive method in CA pathology diagnostics enabling accurate identification of stenosis location, extent, degree and characteristics. Scanning protocol individualization in CCTA enables significant reduce of RD. References 1. 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